Diagnóstico comunitario mediante técnicas cualitativas de las expectativas y vivencias en salud de una zona necesitada de transformación social / Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation

Objetivo: Conocer las opiniones, vivencias y expectativas sobre la atención prestada por el Sistema Sanitario Público Andaluz (SSPA) de los usuarios de una zona urbana necesitada de transformación social (ZNTS). Diseño: Metodología cualitativa, estudio exploratorio. Emplazamiento: Zona básica de salud urbana (16.000 habitantes; 40% ZNTS). Participantes: Usuarios del SSPA mediante muestreo intencional de usuarios y líderes de la comunidad. Criterios de homogeneidad: edad. Criterios de heterogeneidad: sexo, frecuentación, activo/pensionista, nivel cultural/económico. Intervenciones principales: Técnicas conversacionales registradas mediante videograbación y moderadas por una socióloga (grupos de discusión para usuarios y entrevistas en profundidad para líderes sociales). Análisis con transcripción literal de los discursos, codificación, triangulación de categorías y obtención de resultados. Resultados: Siete grupos (43 participantes; 58% ZNTS) y 6 líderes sociales. Se desea continuidad en la atención y libre elección de profesionales, criticando cambios sin información previa y la discontinuidad atención primaria/hospitalaria. Hay mala accesibilidad física por el entorno urbano y críticas a los servicios de admisión y los trámites burocráticos; la cita previa y la receta electrónica son mejoras pero solicitan más derivaciones y revisiones hospitalarias. Hay buena valoración de los profesionales (atención primaria-mayor cercanía, hospital-mayor capacidad técnica). Se precisa mejorar la formación de enfermería y la rapidez de la asistencia urgente. Hay falta de liderazgo en la organización del SSPA, muy fragmentada. Se conoce una oferta de servicios centrada en la demanda asistencial, siendo poco difundidas otras actividades. Conclusión: El SSPA debe incorporar las opiniones y expectativas de las comunidades en riesgo social para una mejora real de la calidad asistencial (AU)

Objective: To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). Design: Qualitative methodology (exploratory study). Location: Urban basic health zone (16,000 inhabitants, 40% ZNTS). Participants: Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. Main interventions: Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). Analysis: transcription of speeches, coding, categories triangulation and final outcome. Results: Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. Conclusion; The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care (AU)

[Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation]. / Diagnóstico comunitario mediante técnicas cualitativas de las expectativas y vivencias en salud de una zona necesitada de transformación social.

OBJECTIVE: To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). DESIGN: Qualitative methodology (exploratory study). LOCATION: Urban basic health zone (16,000 inhabitants, 40% ZNTS). PARTICIPANTS: Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. MAIN INTERVENTIONS: Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). ANALYSIS: transcription of speeches, coding, categories triangulation and final outcome. RESULTS: Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. CONCLUSION: The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care.

Motivaciones para el consumo de tabaco entre los adolescentes de un instituto urbano / Motivations for tobacco consumption among adolescents in an urban high school

Objetivo Conocer las motivaciones (actitudes, creencias y experiencias) de los adolescentes para el consumo de tabaco. Método Diseño cualitativo con videograbación de seis grupos de discusión (6-8 adolescentes, 50 minutos), curso escolar 2008/09. Muestreo intencional de adolescentes (12-18 años) de un instituto urbano de clase media (Jaén-España), usando el nivel educativo como criterio de homogeneidad y el sexo/consumo como criterio de heterogeneidad. Análisis de contenido: codificación, triangulación de categorías y obtención/verificación de resultados. Resultados Cuarenta y cuatro adolescentes, 54% varones. Fumar relaja y mejora la imagen personal: da seguridad (chicos) y mejora las relaciones con el sexo opuesto, además de controlar el peso (chicas). La familia favorece el tabaquismo por imitación de comportamientos, aunque no lo normaliza. Los amigos constituyen un grupo de presión para el inicio/mantenimiento del consumo. El inicio de la educación secundaria marca el principio del consumo experimental. La sociedad suele normalizar el consumo y es fácil para los menores de edad comprar tabaco. Los universitarios son un modelo a seguir, con libertad para el consumo. Piden ejemplo de abstinencia a progenitores y educadores/sanitarios, dicen estar bien informados, pero recuerdan sólo mensajes impactantes. De forma unánime indican que el tabaco provoca adicción, pero de manera proporcional al tiempo de consumo; sólo les preocupan los síntomas inmediatos provocados por el tabaquismo. Los adolescentes fumadores relacionan el policonsumo con los momentos de ocio. Conclusiones El estudio aporta motivos potencialmente útiles para mejorar la intervención antitabaco en los adolescentes. La influencia de los amigos, las actitudes parentales, la accesibilidad al tabaco y los síntomas de dependencia parecen ser los factores más relevantes(AU)

Objective To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents. Methods This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaén, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results .Results There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time. Conclusions This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence (AU)

[Evolution of the consumption of toxic substances among the adolescents of an urban area (1997-2004)]. / Evolución del consumo de sustancias tóxicas en los adolescentes de una zona urbana (1997-2004).

OBJECTIVES: To find the evolution of the consumption of alcohol, tobacco and other drugs among adolescents in an urban area. DESIGN: Descriptive, cross-sectional study using a self-administered questionnaire. SETTING: Secondary school (middle-class urban area). PARTICIPANTS AND MEASUREMENTS: Six hundred and seventy-eight students took part in the years 1997, 2001, and 2004. MEASUREMENTS AND MAIN RESULTS: The questionnaire included questions on age, sex and consumption of toxic substances. The following figures are given in order of the year of study. We studied 172, 249, and 257 adolescents, with a mean age of 14 (interval, 12-17) and equality of sexes. The proportion of adolescents with no consumption of toxic substances increased (21%+/-3.1%; 34%+/-3.0% 56%+/-3.1%; P<.001, chi2), basically because alcohol consumption dropped (58%+/-3.6%; 61%+/-3.2%; 41%+/-3.1%; P<.001, chi2), although its weekend consumption increased (84%+/-2.6%; 85%+/-2.2%; 96%+/-1.2%; P<.05, chi2), especially of spirits. Tobacco consumption increased (12%+/-2.4%; 21%+/-2.3%; 29%+/-2.4%; P<.001, chi2) with a pattern of daily smoking (9%+/-0.6%; 34%+/-3.2%; 47%+/-3.1%; P<.01, chi2). The consumption of illegal rugs also increased (9%+/-0.6%; 24%+/-2.8%; 16%+/-2.4%; P<.001, chi2), with an intermittent pattern of consumption (87%+/-1.6%; 71%+/-2.3%; 85%+/-1.8). Cannabis is the most used drug (>90%), cocaine use fell and design drug use increased. Age affected consumption, but sex did not. CONCLUSIONS: In the last 8 years the consumption of toxic substances among adolescents has dropped, mainly because of less alcohol consumption. However, new forms of consumption of alcohol and other illegal drugs, especially at weekends, emerged and daily consumption of tobacco increased.

Evolución del consumo de sustancias tóxicas en los adolescentes de una zona urbana (1997-2004) / Evolution of the consumption of toxic substances among the adolescents of an urban area

Objetivos. Conocer la evolución del consumo de alcohol, tabaco y otras drogas entre adolescentes de una zona urbana. Diseño. Descriptivo, transversal, mediante encuesta autoadministrada. Emplazamiento. Instituto de enseñanza secundaria (zona urbana de clase media). Participantes. Un total de 678 alumnos durante los años 1997, 2001 y 2004. Mediciones y resultados principales. Se recogieron datos de la edad, el sexo y el consumo de sustancias tóxicas. Los resultados se exponen según el año de estudio. Se estudian 172, 249 y 257 adolescentes, respectivamente, con mediana de 14 años (intervalo, 12-17 años) e igualdad de sexos. Se incrementa el número de adolescentes que no han consumido ningún tóxico (21 ± 3,1%, 34 ± 3,0%, 56 ± 3,1%; p 90%), disminuye el uso de cocaína y aumentan las drogas de diseño. La edad influye en el consumo, pero no el sexo. Conclusiones. En los últimos 8 años ha disminuido el consumo de tóxicos entre los adolescentes, sobre todo por una menor ingesta de alcohol. Sin embargo, aparecen nuevas formas de consumo de alcohol y otras drogas, sobre todo durante el fin de semana, y se incrementa el consumo diario de tabaco

Objectives. To find the evolution of the consumption of alcohol, tobacco and other drugs among adolescents in an urban area. Design. Descriptive, cross-sectional study using a self-administered questionnaire. Setting. Secondary school (middle-class urban area). Participants and measurements. Six hundred and seventy-eight students took part in the years 1997, 2001, and 2004. Measurements and main results. The questionnaire included questions on age, sex and consumption of toxic substances. The following figures are given in order of the year of study. We studied 172, 249, and 257 adolescents, with a mean age of 14 (interval, 12-17) and equality of sexes. The proportion of adolescents with no consumption of toxic substances increased (21%±3.1%; 34%±3.0% 56%±3.1%; P90%), cocaine use fell and design drug use increased. Age affected consumption, but sex did not. Conclusions. In the last 8 years the consumption of toxic substances among adolescents has dropped, mainly because of less alcohol consumption. However, new forms of consumption of alcohol and other illegal drugs, especially at weekends, emerged and daily consumption of tobacco increased